Placement of coils and embolism material by interventional radiology is crucial for the management of vascular bleedings caused by gastric varices, arterial aneurysms or gastrointestinal ulcers. In rare cases these particles migrate through the gastrointestinal wall and become visible during endoscopy. Here a series of 7 patients with migrated coils was analyzed regarding their management and outcome. 

Seven patients were retrospectively identified in 3 German tertiary hospitals in the years 2020-2024. Data on age, gender, indication of coil placement, time to detection and anatomic location of migration, complications, and their management was collected. 

The 2 female and 5 male patients had a mean age of 64.7 ±16.7 years at the time point of embolization by interventional radiology. Active bleeding necessitated interventional radiology in 4 patients, 3 of which were located in the duodenum and one from a pseudoaneurysm from the right hepatic artery. Prophylactic treatment reasoned the placement of embolism material in 2 patients with varices located in the gastric fundus and esophagus and in one patient with a pseudoaneurysm of the splenic artery. The mean time to detection of migration was 483 ±523 days including two early migrations within the first 5 days. All patients were alive at the last follow-up after a mean of 619 ±649 days. Location of migration was the duodenum in 3 cases, the stomach in 2 cases and the jejunum and pancreatic duct in one case each. In 6 of 7 of cases migrated material was left in place as patients remained asymptomatic. The patient with coil migration into the pancreatic duct presented with a pancreatitis 47 months after placement of 19 coils. In this specific case coils were applied for treatment of the dissection of a pseudoaneurysm of the splenic artery and coeliac trunk. Surgical resection of the left pancreas was performed to retrieve coil material which by itself was complicated by pancreatic fluid leakage from the resection margin resulting in EUS-guided drainage. 

Coil migration represents a rare complication after vascular embolization by interventional radiology. Our case series supports conservative management in the cases of migration into the lumen of the gastrointestinal tract. Penetration into the pancreatic duct was documented in one case requiring surgical and endoscopic treatment.